Augmentin Dosing for Community-Acquired Pneumonia
For community-acquired pneumonia, the recommended Augmentin (amoxicillin-clavulanate) dosing is 875 mg/125 mg twice daily or 2000 mg/125 mg twice daily for outpatients with comorbidities. 1
Outpatient Treatment
Patients without comorbidities:
- Augmentin is not typically first-line therapy for healthy outpatients without comorbidities 1
- For these patients, amoxicillin 1g three times daily is the preferred first-line agent 1
Patients with comorbidities:
- Augmentin is recommended for outpatients with chronic heart, lung, liver, or renal disease; diabetes mellitus; alcoholism; malignancy; or asplenia 1
- Dosing options:
- 500 mg/125 mg three times daily, or
- 875 mg/125 mg twice daily, or
- 2000 mg/125 mg twice daily 1
- Should be combined with a macrolide (azithromycin or clarithromycin) or doxycycline for atypical pathogen coverage 1
Inpatient Treatment (Non-ICU)
- For hospitalized non-ICU patients, Augmentin is not specifically mentioned in the most recent guidelines 1
- The preferred β-lactams for inpatients are cefotaxime, ceftriaxone, ampicillin-sulbactam, or ceftaroline 1
Special Populations and Considerations
Patients with recent antibiotic use:
- If a patient has received antibiotics within the past 3 months, an alternative from a different class should be selected 1
- For patients with recent β-lactam use, consider a respiratory fluoroquinolone instead 1
Drug-resistant Streptococcus pneumoniae:
- High-dose amoxicillin-clavulanate (2000 mg/125 mg twice daily) is effective against S. pneumoniae with reduced susceptibility to penicillin 1, 2
- This pharmacokinetically enhanced formulation (Augmentin XR) maintains coverage of β-lactamase-producing pathogens while increasing activity against resistant pneumococci 3
β-lactamase producing organisms:
- Augmentin is effective against common respiratory pathogens that produce β-lactamase, including Haemophilus influenzae and Moraxella catarrhalis 4
- The addition of clavulanate to amoxicillin protects against β-lactamase-mediated resistance 4
Duration of Therapy
- Standard duration for community-acquired pneumonia is 5-7 days for uncomplicated cases 5
- Longer courses (10-14 days) may be needed for more severe infections or complicated cases 5
Common Pitfalls and Caveats
- Using standard-dose amoxicillin-clavulanate for areas with high prevalence of drug-resistant S. pneumoniae may lead to treatment failure 1
- Monotherapy with Augmentin without atypical coverage (macrolide or doxycycline) may miss atypical pathogens like Mycoplasma pneumoniae or Chlamydophila pneumoniae 1
- Augmentin should not be used if the patient has had recent exposure to amoxicillin or amoxicillin-clavulanate due to increased risk of resistance 1
- For severe pneumonia requiring ICU admission, Augmentin alone is insufficient; combination therapy with coverage for atypical pathogens is required 1
International Perspective
- In Chile, for outpatients over 65 years and/or with comorbidities, the recommended dose is amoxicillin-clavulanate 500/125 mg three times daily or 875/125 mg twice daily for 7 days 6